Nonfixation Of Mesh Research Articles

Meta-analysis of RCTs on the safety of non-fixation of mesh in TAPP inguinal hernia repair: an updated meta-analysis

ObjectiveThis meta-analysis aims to compare the clinical efficacy of mesh non-fixation and fixation in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair, systematically evaluating the application value of the mesh non-fixation technique in clinical settings.MethodsA computerized search of PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases was conducted to identify randomized controlled trials (RCTs) comparing mesh non-fixation and fixation in TAPP inguinal hernia repair. Meta-analysis was performed using RevMan 5.3 software, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence grading system was employed for outcome quality assessment. Publication bias analysis was performed using Begg’s test. A trial sequential analysis (TSA) was performed using TSA 0.9.5.10 Beta software.ResultsA total of nine RCTs involving 1,879 inguinal hernia patients were included. Meta-analysis results demonstrated that, compared to the fixation group, the non-fixation group exhibited significantly lower seroma occurrence rate [RR = 0.43, 95% CI (0.20, 0.89), P = 0.02, heterogeneity P = 0.28, I²=22%], Visual Analog Scale (VAS) pain score at 6 months postoperatively [MD=-0.21, 95% CI (-0.29, -0.12), P < 0.00001, heterogeneity P = 0.34, I²=0%], and cost [MD=-3.23 thousand yuan, 95% CI (-4.26, -2.19), P < 0.00001, heterogeneity P = 0.0003, I²=92%]. There were no statistically significant differences in overall complication rate [RR = 0.88, 95% CI (0.62, 1.23), P = 0.45, heterogeneity P = 0.11, I²=44%], overall infection event rate [RR = 0.96, 95% CI (0.36, 2.56), P = 0.93, heterogeneity P = 0.62, I²=0%] and recurrence rate [RR = 0.75, 95% CI (0.28, 1.99), P = 0.56, heterogeneity P = 0.44, I²=0%] between the two groups. The results of the TSA indicated that the observed lower seroma occurrence rate in the non-fixation group compared to the fixation group requires further validation through the inclusion of additional RCTs.ConclusionMesh non-fixation in TAPP inguinal hernia repair is deemed safe and does not elevate the risk of hernia recurrence. However, given certain limitations in this study, future comprehensive and reliable validation will require further multicenter, high-quality, large-sample double-blind RCTs.

Comparison of early postoperative pain in mesh fixation versus without fixation in open Lichtenstein mesh hernioplasty

Background &amp; Objective: Inguinal hernia is a frequently encountered issue in surgical practice. Surgical techniques for hernia repair have significantly advanced and improved. The study objective was to compare early postoperative pain in mesh fixation versus without fixation in open Lichtenstein mesh hernioplasty regarding early postoperative pain. Methods: A randomized control trial was done at the Department of Surgery of the Federal Government Services Hospital, Islamabad from April to December 2023. Total 60 patients meeting the inclusion criteria and were presented with inguinal hernia. Randomly patients were divided into two groups, each consisting of 30 patients and were managed with Lichtenstein repair followed by either suture fixation for mesh or non-fixation of mesh. Patients from both groups were observed for 24-hours and early postoperative pain was recorded using visual analog scale (VAS). The data underwent analysis utilizing SPSS v 25. Results: The mean age of the patients was 46.0±9.2 years. Among 60 patients, 36 (60%) men and 24 (40%) women. The average BMI was 26.34±4.27 kg/m2. No significant difference was observed in postoperative pain between two groups (p ≥ 0.05). A t-test was utilized to compare the VAS score between two groups and it was observed the results insignificant except in patients with BMI less than 25 (p ≤ 0.05). Conclusion: There is no difference in occurrence of postoperative pain in fixed versus non-fixed mesh.

A Long-Term Study on Recurrence, Chronic Pain, and Quality of Life in Obese Patients with Groin Hernia undergoing Laparoscopic Total Extraperitoneal Hernia Repair: Comparison between Mesh Fixation and Nonfixation Techniques.

"Laparoscopic Total Extraperitoneal (TEP)" repair of hernia is a common surgical procedure for treating groin hernias. This study focused on the long-standing assessment of "quality of life (QoL)," chronic pain, and recurrence to compare the effectiveness of TEP hernia surgery with "mesh fixation (MF)" against "nonfixation (NF)" in patients who are obese with a BMI of 35 kgs/m2 or higher. In this study's randomized controlled experiment, 73 obese individuals with groin hernias underwent total extraperitoneal hernia repair with either MF (n = 35) or NF (n = 38). A check-up was conducted 1, 3, and 5 years after the operation. Recurrence, chronic pain, and QoL were assessed using a physical examination and validated questionnaires. There were no changes between the subjects of either group in baseline characteristics, hernia recurrence rate, chronic pain rate, or QoL. There were neither significant variations in surgical complications nor hospital stay duration. The results suggest that treating TEP hernias among people with a BMI of 35 kgs/m2 or above with mesh NF may be successful. The recurrence rates among the subject groups were not substantially different; however, NF was linked with reduced rates of chronic pain which would be beneficial for patient satisfaction and recovery. To decide the optimal technique for MF in TEP hernia repair, these findings need to be verified by additional studies.

Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials

BackgroundWhether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial. MethodsThe PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software. ResultsFifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09). ConclusionUnfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.

Evaluation of Outcome of Laparoscopic Transabdominal Pre Peritoneal Repair of Inguinal Hernia with Special Reference to Comparison of Result between Fixation and Non Fixation of Mesh

Evaluation of Outcome of Laparoscopic Transabdominal Pre Peritoneal Repair of Inguinal Hernia with Special Reference to Comparison of Result between Fixation and Non Fixation of Mesh

English

BACKGROUND The debate between fixation and non-fixation of mesh in laparoscopic hernia surgery has been going since the advent of this technique. While earlier studies insisted on mesh fixation, emerging studies are now supporting elimination of mesh fixation. Therefore, a prospective comparative study was performed in tertiary health care centre in northern India to compare the incidence of recurrence, post-operative pain and chronic groin pain between mesh fixation and non-fixation. In this study, we wanted to compare the intra-operative complications, post-operative pain and recovery, duration of hospital stay, incidence of chronic groin pain and pain during follow up visits and incidence of recurrence in laparoscopic inguinal hernia repair between fixation and non-fixation of mesh. METHODS A prospective comparative study was conducted among 50 patients admitted in surgery unit in a tertiary health care centre in northern India from January 2019 to October 2020 and were divided into two groups (group A - fixation, group B - non-fixation). Different factors such as post-operative pain, analgesia required post-operatively, duration of hospital stay, chronic groin pain and recurrence were compared between the two groups. Patients were followed up at 1, 3, 6 and 12 months. RESULTS The mean pain score at the end of 1 month and 3 months was higher in patients in the mesh fixation group. The days required by patients to resume their routine activities was lesser in patients in the non-fixation group. The recurrence rate was found to be similar in both the groups. CONCLUSIONS Mesh fixation offers no clear advantage over non-fixation and non-fixation can be considered as the preferred alternative as this procedure has less chance of postoperative pain, early ambulation and no increased risk of recurrence. KEYWORDS Laparoscopic Inguinal Hernia Repair, Mesh Fixation, Mesh Non-Fixation

Impact of mesh fixation vs non-fixation in laparoscopic transabdominal preperitoneal inguinal hernia repair on chronic groin pain and quality of life: a prospective randomized study

Aim A randomized controlled study comparing the impact of fixation vs non-fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty on chronic groin pain and quality of life of patients. Patients and methods This study includes 100 patients presented with primary unilateral indirect inguinal hernia treated at Benha University Hospital from June 2016 to August 2018. Patients were randomized to TAPP inguinal hernia repair with fixation of mesh (group A, n=50) and without fixation of mesh (group B, n=50). Parameters assessed included operative duration, time to early ambulation, postoperative pain, and postoperative complications and quality of life. Assessment of pain was done using the visual analog scale at 1 day, 3 months, and 6 months after surgery. Evaluation of quality of life was done using the 36-item short-form health survey 3 months postoperatively. Results The mean operative duration and time to early ambulation in group B (without mesh fixation) were reduced significantly in comparison to group A (with mesh fixation). The visual analog scale score at 1 day, 3 months, and 6 months after surgery for group B was significantly lower than in group A. The physical function (PF), bodily pain (BP), role physical (RP), and general health (GH) in group B were significantly higher than group A while there is no statistically significant difference in vitality (VT), role emotional (RE), social function (SF), and mental health (MH) between group A and group B. Conclusion Mesh fixation and non-fixation in laparoscopic TAPP approach for the repair of inguinal hernia are comparable regarding operative duration, postoperative complications, and time to ambulation while pain scores and quality of life were significantly better in the non-fixation group.

Comparison of mesh ixation and nonixation in laparoscopic transabdominal preperitoneal repair of inguinal hernia

Introduction: Application of preperitoneal mesh method in the treatment of inguinal hernia can be regarded as one of the successful methods in this regard. However, the impact of mesh fixation or nonfixation on the recurrence of hernia and the incidence of its complications have not been thoroughly investigated.The present study aimed at comparing the effect of mesh fixation and nonfixation on transabdominal preperitoneal (TAPP) laparoscopy for inguinal hernia repair. Materials and Methods: In this study, eighty patients with inguinal hernia underwent TAPP laparoscopy with mesh fixation (n = 41) and nonfixation (n = 39). Mesh was fixed using a suture in Group A and nonfixed in Group B. Then, the duration of operation, length of in-hospital stay, complications and recurrence of hernia, and pain severity 1 day after the surgery, during discharge, at the 1st and 2nd weeks, and at 1 and 6 months after the surgery were compared between the two groups. Results: The length of in-hospital stay and return to work in Group B was statistically significantly lower than that of Group A (P 0.05). The level of pain was generally higher in Group A and was statistically significant 1 and 2 weeks after the surgery (P Conclusion: Mesh nonfixation causes less postoperative complications and pain in patients undergoing TAPP repair; however, in long-term follow-up, the level of chronic pain following the application of mesh fixation and non-fixation methods is not different.

To compare advantage of non-fixation versus fixation of mesh in Laparoscopic totally Extra Peritoneal (TEP) repair of inguinal hernias

Background: Mesh fixation during laparoscopic totally extra peritoneal repair is thought to be necessary to prevent recurrence of infections and post-operative complications. However, mesh fixation might increase the postoperative complications and chronic pain. This study was to describe the experience of a single surgeon at R.G. Kar Medical College and Hospital performing this operation. This study evaluates the outcomes of laparoscopic hernioplasty performed with and without mesh fixation at our institution.Aims and Objective: To compare advantage of non-fixation versus fixation of mesh in laparoscopic Totally Extra peritoneal (TEP) repair of inguinal hernias. This study was conducted for analysis of outcome with respect to pain, operative time, intra and postoperative complication, days of hospital stay, recurrence regarding the procedure between fixation and non-fixation of mesh in totally extra peritoneal repair of inguinal hernia.Materials and Methods: The study was conducted in the Department of Surgery, R.G.Kar Medical College and Hospital from January 2011 to April 2012. All patients admitted in General surgical unit presenting with uncomplicated unilateral inguinal hernias were included. A total of 60 patients were included in the study, of which 30 patients underwent TEP repair without fixation of mesh and for remaining 30 patients the mesh was fixed using metallic tacks.Results: Difference in average pain score at 24 hrs, 72 hrs, 1 month and 6 months was significant statistically (p =0.003, p = 0.003, p&lt; 0.001 and p=0.001 respectively) when compared in both groups. There was no recurrence in the study period in either of the groups. The duration of operative time and days of hospital stay was higher in fixation group and was statistically significant.Conclusion: Mesh fixation appears to be disadvantageous in TEP repair of inguinal hernias compared to non- fixation of mesh as it is associated with higher operative time, higher postoperative complication and an increased likelihood of developing chronic groin pain. The omission of mesh fixation did not increase the risk of early hernia recurrence.Asian Journal of Medical Sciences Vol.9(4) 2018 35-40

Non-fixation Versus Fixation of Mesh in Totally Extraperitoneal Repair of Inguinal Hernia: a Comparative Study.

Two major issues with laparoscopic inguinal hernia (IH) repair are recurrences and chronic groin pain (CGP). The procedure involves fixing the mesh with the tackers which is believed to increase the rate of CGP due to nerve injuries. Thus, non-fixation of mesh is being proposed but concerns remain regarding increased recurrences. We sought to look at our outcomes after we switched over to non-fixation of mesh in totally extraperitoneal repair (TEP). Retrospective review of prospectively maintained database of 171 repairs was done on 122 patients (fixation 59 and non-fixation 112) during a period of 4years with an endeavor to complete a minimum of 1year of clinical follow-up. The primary objective was to assess the recurrence rates and CGP and the secondary objective was to assess operative times, immediate post-op pain, incidence of urinary retention, duration of hospital stay, days taken to return to activity, and cost. The mean operative times for unilateral IH for the fixation and non-fixation groups were 41.8 ± 11.4 and 35.9 ± 9.7min, respectively (p = 0.021), whereas for bilateral were 66.2 ± 15.6 and 55.3 ± 14.2min, respectively (p = 0.018). The mean pain score was 3.44 ± 1.2 versus 3.01 ± 1.0; (p = 0.037) in the two groups, respectively. At a mean follow-up of 33.2 ± 17.0 and 18.7 ± 6.2months, the incidence of CGP was 02 (3.4%) and 3 (2.7%) (p = 1.000) and recurrences were 02 (3.4%) in the two groups, respectively (p = 0.118). Non-fixation of mesh in TEP does not lead to increased recurrence though it does not decrease the incidence of chronic groin pain. Collateral advantage would be decreased operative times, lesser post-operative pain, and decreased costs.

Tack fixation versus nonfixation of mesh in laparoscopic transabdominal preperitonaeal hernia repair

Context Laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia is traditionally performed by fixing the mesh to the abdominal wall by spiral tacks. However, mesh fixation might not be necessary as there is little space for the mesh to migrate; besides, tack fixation predisposes to postoperative pain. Aim The present study aimed to compare mesh fixation versus nonfixation regarding postoperative pain and recurrence rates. Settings and design This study was a prospective, controlled, randomized study. Patients and methods In total, 60 patients with inguinal hernias were divided into two equal groups, were compared regarding mesh fixation versus nonfixation by TAPP technique, and followed-up for up to 12 months for postoperative complications, pain, and recurrence. Statistical analysis Continuous variables are expressed as means and SDs. Categorical variables are expressed as frequencies and percentages. Results There was significant reduction in postoperative pain and chronic pain in patients without mesh fixation in comparison with patients with mesh fixation and early return to work. There was no significant difference between the two groups regarding postoperative complications and recurrence rates. Conclusion Mesh nonfixation reduces the incidence of postoperative pain and chronic pain in patients undergoing TAPP repair without increase in postoperative complications or recurrence rates.

Mesh Encircling Total Extraperitoneal (TEP) Repair of Inguinal Hernia without a Fixation Material or Preformed Mesh: Overlay Closure of Slit Without Additional Mesh

Purpose: Mesh non-fixation in TEP is associated with lower cost and shorter operative time, and it is safe and recommended when performed by an experienced surgeon. In performance of TEP surgery using a non-fixation mesh, particularly by a non-experienced surgeon, prevention of mesh migration is an important issue for mesh application. The aim of this study was to report on a fixation method using a non-preformed mesh encircling a cord structure without the use of tacks, staples, or fibrin sealants in TEP surgery. Methods: A total of 41 patients who had undergone mesh-encircling TEP without fixation from December 2008 (first case of surgery) to June 2012 were analyzed. Results: The mean follow-up period was 23.2 months (12~35 months). Three patients complained of scrotal discomfort, and one patient complained of scrotal edema, but they were resolved with conservative management. There was no recurrence during the follow up period. Conclusion: The method of mesh-encircling TEP without fixation material and no additional mesh in which the slit of the mesh is wrapped around the cord structure using an overlay suture is a simple and safe technique without compromising recurrence or chronic pain.

Feasibility of Incremental Laparoscopic Inguinal Hernia Repair Development in China: An 11-Year Experience

Our objective was to investigate the feasibility of laparoscopic inguinal hernia repair during its developmental phases in China. The clinical data of 2,056 patients (2,473 hernias) who underwent laparoscopic inguinal hernia repair at Shanghai Minimally Invasive Surgery Center between January 2001 and December 2011 were analyzed retrospectively. The operation priority was used to divide the patients into 7 groups for analysis of the learning curve. There were 1,005 transabdominal preperitoneal patch plastic repairs (TAPP), 1,458 total extraperitoneal repairs (TEP), and 10 intraperitoneal onlay mesh repairs performed on 874, 1,175, and 7 patients, respectively. Median follow-up period was 60 months. The operation time and postoperative hospital stay for TEP were considerably shorter than those for TAPP. The complication rate for TEP, especially seroma, was considerably lower. Transabdominal preperitoneal patch plastic repair was performed in 81.4% of the recurrent inguinal hernias. Seven patients underwent unilateral intraperitoneal onlay mesh repair and 3 others underwent unilateral intraperitoneal onlay mesh repair and TAPP on the opposite. Most of patients with grade I and II hernias underwent TEP. The learning curve has demonstrated that more obstacles occurred in the earlier phase of the laparoscopic inguinal hernia repair training, supported by findings such as fewer cases performed annually, longer operation time, and higher incidence of complications and recurrence. These findings have improved as experience is accumulated through more operations. In addition, the ratios of TEP to TAPP and mesh nonfixation to fixation also evolved throughout the course of the study. Laparoscopic inguinal hernia repair is a feasible technique that can be popularized in China.

Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia

We thank Christophe Berney for his interesting and very important Letter to the Editor, in which he addresses a number of aspects of the evidence-based technique of total extraperitoneal patchplasty (TEP) discussed in the ‘‘Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia’’ [1]. The technique must once again be clarified in more precise terms. At issue is the role of fibrin sealant for mesh fixation in TEP and the implications of the role of fibrin sealant in seroma formation. Christophe Berney reports on his own experiences with fibrin sealant for mesh fixation in 650 TEP operations with low complication and recurrence rates [2]. In the subsection entitled ‘‘Should a drain be used after a TEP repair? Should seromas be aspirated?’’ [1, p. 2794], the study by Lau [3] is cited as a level 1B statement. In that prospective randomized comparative study of bilateral inguinal hernias, it was noted that the use of fibrin sealant compared to staples for mesh fixation in TEP led to a significant reduction in the need for analgesics, but it also led to a significant rise in the rate of postoperative seromas. Here it is important to focus on the definition used by Lau [3] for a postoperative seroma: ‘‘A seroma was defined as the clinical presence of a palpable fluid collection over the groin in the absence of bruising during follow-up.’’ Also noteworthy in the Lau study [3] is that the proportion of direct hernias was very high, amounting to 56.5% in the fibrin sealant group and 58.5% in the staple group. In the Lau study [3] a clinically palpable seroma with protrusion of the skin was noted in only 5.3% of cases in which staples were used and in 17.4% (p = 0.009) of cases in which fibrin sealant was used for mesh fixation. Therefore, by virtue of the Lau study [3], it must be borne in mind that mesh fixation to Cooper’s ligament with staples tends to be more suitable for prevention of a clinically palpable seroma with protrusion of the skin in the groin after a TEP operation for direct hernias. The classification system used in the Guidelines means that queries relating to both TEP and TAPP are dealt with in separate sections. Therefore, further statements and commentaries on the issues raised by Christophe Berney can be checked in Chapter 9, ‘‘Mesh fixation modalities: is there an association with acute or chronic pain?’’ and Chapter 10, ‘‘Risk factors and prevention of acute and chronic pain.’’ On p. 2822 there is a clear statement on the scientific level 1B whereby the risk of acute and chronic pain after staple mesh fixation is higher compared with fibrin fixation or nonfixation. On p. 2817 nonfixation of mesh in TEP is then elaborated on in greater detail: ‘‘In total, seven studies have compared fixation versus nonfixation in TEP, of which only two have 1 B evidence level. They did not discover any difference in the incidence of recurrence between fixated versus nonfixated mesh. In total, 12,114 hernia repairs F. Kockerling D. A. Jacob (&) Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Neue Bergstr. 6, 13585 Berlin, Germany e-mail: dietmar.jacob@vivantes.de

Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India

Several studies have shown that nonfixation of mesh in total extraperitoneal (TEP) inguinal hernia repair is safe and has no disadvantage compared to mesh fixation in terms of recurrence rate, pain scores, and other morbidity parameters. The aim of this study was to compare the effect of nonfixation of mesh with fixation in laparoscopic TEP inguinal hernia repair in a rural hospital in India. One hundred four patients were randomized to mesh nonfixation group or a fixation group during TEP. The postoperative pain scores on a visual analog scale (VAS) at 24 h, 1 week, 1 month, and 1 year, urinary retention, seroma formation, length of hospital stay, days taken to resume normal activities, and recurrence after 2 years were analyzed. The trial was registered at www.clinicaltrials.gov (ID: NCT01117337). One hundred four patients (194 hernias) were randomized to mesh nonfixation or fixation. The pain scores at 24 h were comparable (Fix, 1.31 ± 0.4; Nonfix, 1.42 ± 0.5, P = 0.23). The length of hospital stay (Fix, 1.12 ± 0.3 days; Nonfix, 1.15 ± 0.4 days, P = 0.7) and days taken to resume normal activities (Fix, 7.77 ± 1.3 days; Nonfix, 7.96 ± 1.15 days, P = 0.44) were also similar for both groups. The mean pain scores at 1 week (Fix, 1.25 ± 0.5; Nonfix, 1.34 ± 0.6, P = 0.42), 1 month (Fix, 1.06 ± 0.2; Nonfix, 1.17 ± 0.4, P = 0.12), 1 year (Fix, 1.04 ± 0.2; Nonfix, 1.13 ± 0.4, P = 0.11), and 2 years (Fix, 1.03 ± 0.2; Nonfix, 1.0, P = 0.17) were comparable for both groups. There was no recurrence in either group at a minimum follow-up of 2 years. There was no significant difference between fixation and nonfixation of mesh in TEP inguinal hernia repair with respect to postoperative pain, length of hospital stay, resumption of normal activities, seroma formation, and recurrence rate. Nonfixation of mesh is safe and recommended in TEP inguinal hernia repair when done by an experienced surgeon, even in a rural setting. The study highlights the potential for universal application of the procedure.

A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair

Mesh fixation during laparoscopic total extraperitoneal (TEP) inguinal hernia repair is still controversial. Although many surgeons considered it necessary to fix the mesh, some published studies supported elimination of mesh fixation. Therefore, a meta-analysis based on randomized controlled trials (RCTs) was conducted to compare the effectiveness and safety of fixation versus nonfixation of mesh in TEP. RCTs were identified from PubMed, Embase, the Cochrane Library, SCI, and the Chinese Biomedical Literature Database (CBM). Two reviewers assessed the quality of the studies and extracted data independently. The methodological quality was evaluated according to the Cochrane Handbook 5.0.2. Statistical analysis was conducted using the Cochrane software RevMan 5.0.21. Six RCTs involving 772 patients were included. The nonfixation group had advantages in length of hospital stay [MD=-0.37, 95% CI (-0.57, -0.17), p=0.0003], operative time [MD=-4.19, 95% CI (-7.77, -0.61), p=0.02], and costs. However, there was no statistically significant difference in hernia recurrence [OR=2.01, 95% CI (0.37, 11.03), p=0.42], time to return to normal activities [MD=-0.13, 95% CI (-0.45, 0.19), p=0.43], seroma [OR=1.25, 95% CI (0.30, 5.18), p=0.75], and postoperative pain on postoperative day 1 [MD=-0.21, 95% CI (-0.52, 0.10), p=0.18] and day 7 [MD=-0.11, 95% CI (-0.42, 0.20), p=0.47]. Without increasing the risk of early hernia recurrence, the nonfixation of mesh in TEP appears to be a safe alternative that is associated with less costs, shorter operative time, and hospital stay for the selected patients. Further adequately powered RCTs are required to clarify whether mesh fixation is necessary for the patients with different types of hernias and larger hernia defects.

Fixation versus non fixation of mesh in laparoscopic totally extraperitoneal inguinal hernia repair (TEP)

Background: Persistent groin pain is reported by a significant number of patients following laparoscopic totally extraperitoneal hernia repair (TEP). Mesh fixation has been implicated as a possible cause, but is widely considered essential for mesh stabilization and early recurrence prevention. This study questioned whether elimination of fixation of the mesh during TEP inguinal hernia repair leads to decreased postoperative pain or complications, or both, without an increased rate of recurrence. Methods: A randomized prospective study was carried out on 60 adult male patients who underwent laparoscopic TEP inguinal hernia repair with group A (30) or without group B (30) fixation of the mesh. Results: Patients in whom the mesh was not fixed had less postoperative pain (P value <0.001), shorter hospital length of stay (24.2 versus 28.8 and P value <0.034)and used less postoperative narcotic analgesia. No significant differences occurred in the rate of postoperative complications, time to return to normal activity or the difficulty of the operation between the two groups. No hernia recurrences were observed in either group (follow-up range, 1 to 12 months). Conclusion: Non fixation of mesh during laparoscopic TEP inguinal hernia repair significantly reduces the level of postoperative pain, hospital length of stay and the economic cost. On other hand, non fixation of mesh does not lead to an increased rate of recurrence.

Randomized Trial of Fixation vs Nonfixation of Mesh in Total Extraperitoneal Inguinal Hernioplasty

Hypothesis Mesh fixation in the extraperitoneal space during endoscopic total extraperitoneal inguinal hernioplasty might be related to an increase in postoperative pain, morbidity rate, and hospital costs. Design Randomized clinical trial. Setting University teaching hospital. Patients From January 1999 to December 2001, 170 patients with inguinal hernia were invited to participate; 85 patients were randomized to each group. Intervention Total extraperitoneal inguinal hernioplasty with or without mesh fixation using staples. Main Outcome Measures Operating time, morbidity rate, chronic pain, recurrences, and hospital cost were analyzed. Follow-up was considered complete when it included a physical examination at 24 months (mean, 36 ± 12 months). Results The statistical study showed no significant differences with regard to epidemiological factors, hernia type, operating time, morbidity, or recurrences when the mesh was stapled, although the total cost of the process was higher (P Conclusions Stapling the mesh in total extraperitoneal inguinal hernioplasty offers no advantages and increases the cost of the process. Our results suggest the possibility of limiting the use of mesh fixation in total extraperitoneal inguinal hernioplasty to cases of direct bilateral hernias.

Randomized Trial of Fixation vs Nonfixation of Mesh in Total Extraperitoneal Inguinal Hernioplasty—Reply

Randomized Trial of Fixation vs Nonfixation of Mesh in Total Extraperitoneal Inguinal Hernioplasty—Reply

Randomized Clinical Trial of Fixation vs Nonfixation of Mesh in Total Extraperitoneal Inguinal Hernioplasty

Mesh fixation in the extraperitoneal space during endoscopic total extraperitoneal inguinal hernioplasty might be related to an increase in postoperative pain, morbidity rate, and hospital costs. Randomized clinical trial. University teaching hospital. From January 1999 to December 2001, 170 patients with inguinal hernia were invited to participate; 85 patients were randomized to each group. Total extraperitoneal inguinal hernioplasty with or without mesh fixation using staples. Operating time, morbidity rate, chronic pain, recurrences, and hospital cost were analyzed. Follow-up was considered complete when it included a physical examination at 24 months (mean, 36 +/- 12 months). The statistical study showed no significant differences with regard to epidemiological factors, hernia type, operating time, morbidity, or recurrences when the mesh was stapled, although the total cost of the process was higher (P<.001). Stapling the mesh in total extraperitoneal inguinal hernioplasty offers no advantages and increases the cost of the process. Our results suggest the possibility of limiting the use of mesh fixation in total extraperitoneal inguinal hernioplasty to cases of direct bilateral hernias.